Aspiration und "near drowning"

Aspiration of toxic substances, foreign material, bacterially contaminated secretions, or water (near-drowning) either immediately leads to cessation of respiration or to impaired ventilation due to airway obstruction, it causes hypoxia due to surfactant dysfunction, and pulmonary infection might develop. Respiratory insufficiency is the resulting consequence which needs immediate and appropriate therapy and intervention. The knowledge of risk factors that promote aspiration injury is important for its prevention and limitation. Mortality varies between 3 and 70 % depending on patients studied, and on the nature and amount of aspirated material. The major cause of death is acute respiratory failure. The onset of injury to the lung after aspiration is very rapid. Therefore, therapeutic interventions like bronchoscopy are often too late. More importantly, oxygenation should be monitored continuously for timely institution of mechanical ventilation. Antibiotics should not be given routinely but a calculated regime is neccessary when signs of infection develop. Prognosis in near-drowning considerably depends on early rescue and successful resuscitation. A rapid onset of cerebral hypothermia during the accident can help to increase the ischemic tolerance of the brain and makes it neccessary to continue advanced life support until rewarming of the near-drowning victim. Anticipation of individual outcome in unconscious patients is difficult. One third of them survive with a moderate to severe neurologic damage. The overall mortality of near-drowning is about 11%. Pathophysiological aspects, diagnostic procedures, pratical management and possible prophylaxis of aspiration injuries will be discussed